The focus of this blog is on the wonders of government-run health-care everywhere but I also note the damage done to private medicine by a legal system that supports predatory litigation.

The long-established socialized medicine systems in Britain and Australia are a particularly relevant warning about where such systems end up.

Posts by John J. Ray (M.A.; Ph.D.)

Friday, December 25, 2009

There Came a Pale Rider

Notwithstanding some minor tinkering, the U.S. Senate has now passed the government takeover of healthcare. And despite the fact that it may not contain all of the far left's extreme demands, it is almost impossible to overstate the nefarious effect of what has emerged.

As Barack Obama has rightly intoned, even as now written, without the "public option," the measure embodies the single most massive government entitlement program since social security. One-sixth of the economy will be summarily placed in the hands of federal bureaucrats. And the greatest health care system in the history of the world will be torn asunder.

Yet, as horrifying as all of that may be, it is just the beginning. Because like the Pale Rider of biblical prophecy, "hell will follow after it."

The Democrats have already made clear that the current bill is just the opening salvo of their all-out assault on every aspect of private health care. As Tom Harkin (D-IA) has said, "What we are buying here is a modest home, not a mansion. But, we can build additions as we go along … In the future, amending it and changing it isn't going to be as tough as passing it in the first place. We amend Medicare and Social Security all the time …That's what we will do in health care."

As Harkin and others have also made clear, a binding public option is inevitable. Full funding of abortions is simply a matter of some minor tinkering. And then, once the new law has inserted the federal government into every aspect of health care, a sprawling new "Department of Health" will be created, empowered to control who receives which medical procedure and – even more chilling – who does not.

And even that doesn't begin to address the full scope of the bill's malevolent intent. More than anything else, the government health care takeover is a sinister political move to insulate the Democrats in power for decades to come.

If the Democrats are allowed to implement their strategy of using the current bill as a foothold to gain a stranglehold, they will then use their newfound power to "redistribute the health" in order to establish a middle-class dependency on bureaucratic dictates and federal subsidies.

As the popular leftwing website TPM recently observed in its editorial "The Death of Conservatism": "[The bill] will re-legitimize middle-class dependence for 'security' on government spending and regulation. It will revive the reputation of the party that spends and regulates, the Democrats, as the generous protector of middle-class interests. And it will at the same time strike a punishing blow against Republican claims to defend the middle class by restraining government."

So, how do conservatives and/or Republicans fight back against this blatant power grab? They have two alternatives left.

First, the Republicans in both the Senate and the House must use any means necessary to prevent the bill's final passage. That may require the most expensive, extensive political ad campaign in TV history. It may also require the most aggressive – and, to some, acrimonious – public attacks in political history. And it will most certainly require the deftest parliamentary machinations in congressional history. In fact, it will likely require all three.

Then, should the bill pass anyway, political activists at the grassroots level must extract an Election Day toll on Senate and House members in marginal seats that will make wayward politicians shudder for decades to come. Even waiting until 2012 will be too late; the Democrat strategy of control and subsidize will already be too far advanced. The electoral pogrom must begin immediately.

The Senate has now passed the government takeover of health care over the objections of the vast majority of Americans. All that remains to be determined is whose hell "will follow after it."

The suspense is over and it is inevitable that the monstrous medical care bill will become law. There is no way to sanitize this thing, period. It is the ultimate “Progressivist” legacy. Paul Krugman, perhaps the most visible “Progressive” today, supports this bill because it vastly expands the scope of the state in our lives. Like most “Progressives,” Krugman believes many things about a state controlled by people he supports. Among the “Progressive” beliefs are:

* “Experts” should decide what is best for everyone;

* The executive branch of government must employ “experts” who can make rules for everyone else;

* Governmental executives (i.e., President of the United States) should not be impeded by legislators, most of whom are not “experts,” and who fail to have the interests of everyone in mind, unlike the “experts” of the executive branch;

* Therefore, the legislative branches of government should defer to the executive branch, provided the “right kind of people” are in the executive’s chair.

Few people actually know everything that exists in this long and convoluted bill. However, that is unimportant, for in the end, the executive branch and its bureaucracies, not Congress, will interpret what the bill contains.

Most people still have the civics book ideas in their heads regarding law and the three branches of government. Americans are taught from grammar school on that the federal government has three branches: Congress, the Executive Branch, and the Federal Courts. According to the civics lessons, Congress makes the laws, the Executive Branch carries out the laws, and the Federal Courts interpret the laws.

That “model” of government disappeared even before the Progressive Era gripped the country a century ago, but it gained in strength during the Great Depression. “Progressives” such as Theodore Roosevelt and Herbert Croly, believed that people had become so advanced through “science” that they no longer needed to be subjected to the messy and (to them) “chaotic” processes of private markets and legislative debate. The “experts” already knew what needed to be done, and anything done by legislatures and markets to delay the directives of the “experts” should be swept away.

Thus, Krugman can write the following, which is fully consistent with the Progressive ethos: "Now consider what lies ahead. We need fundamental financial reform. We need to deal with climate change. We need to deal with our long-run budget deficit. What are the chances that we can do all that — or, I’m tempted to say, any of it — if doing anything requires 60 votes in a deeply polarized Senate?"

Translation: We need government action, not legislative debate. The legislative branch just gets in the way of what we need. (I do find it curious that a person who had advocated the most irresponsible spending in the history of the country now says we must “deal” with the “long-run budget deficit.” What he really means, of course, is that we have to raise taxes through the roof.)

Krugman need not fear, however, for the Obama administration really did not need this bill to take over medical care. Remember the 2009 GM/Chrysler bailouts? They came entirely through the executive branch, while in 1980, Congress had to pass legislation to aid Chrysler. In other words, the financial and regulatory role of Congress has shrunk massively even in the past 30 years.

Likewise, the EPA recently re-interpreted (with permission from the U.S. Supreme Court) the 1990 Clean Air Act Amendments to include carbon dioxide as a “dangerous pollutant.” The original law had no such language, but the EPA simply identified a new pollutant, and it legally can impose “solutions.”

In the end, the bill will be whatever the White House wants it to be. The ultimate legacy of “Progressivism” is that political debate no longer matters. The medical bill was bad legislation and everyone knew it, which was why the political tension was so great. However, now that Congress has given it permission to determine our medical futures, the Obama administration will waste no time imposing oppressive and costly new rules upon us, even if they are not contained in the actual bill Congress passed.

It's time to blow the whistle on two erroneous statements that opponents and proponents of the health care legislation being jammed through Congress have been making. Republicans have been saying that never before has Congress passed such an unpopular bill with such important ramifications by such a narrow majority. Barack Obama has been saying that passage of the bill will mean that the health care issue will be settled once and for all.

The Republicans and Obama are both wrong. But perhaps they can be forgiven because the precedent for Congress passing an unpopular bill is an old one, and the issue it addressed has long been settled, though not by the legislation in question. That legislation was the Kansas-Nebraska Act of 1854. Its lead sponsor was Stephen A. Douglas, at 41 in his eighth year as senator from Illinois, the most dynamic leader of a Democratic Party that had won the previous presidential election by 254 electoral votes to 42.

Douglas' legislative prowess far exceeded that of current Senate Majority Leader Harry Reid. To hold together his 60 Senate Democrats, Reid simply dispensed favors -- eternal Medicaid financing for Ben Nelson's Nebraska, a hospital grant for Chris Dodd's Connecticut, more rural health money for Byron Dorgan's North Dakota and Montana's Max Baucus. Douglas did something far more difficult. He got the Senate to pass a bill some of whose provisions were supported by half of the Senate plus Douglas and some of which were supported by the other half plus Douglas. After passage, Douglas spent a day getting drunk -- a consolation unavailable to the teetotaling Reid.

The issue that Douglas said the Kansas-Nebraska Act would settle forever was slavery in the territories. His bill repealed the 34-year-old Missouri Compromise prohibiting slavery in territories north of Arkansas and substituted popular sovereignty -- territory residents could vote slavery up or down.

We cannot say with assurance that the Kansas-Nebraska Act was unpopular; Dr. Gallup didn't start polling until 81 years later. But the results of the next election were pretty convincing. The Republican Party was suddenly created to oppose the Kansas-Nebraska Act, and the 1854-55 elections transformed the Democrats' 159-71 majority to a 108-83 Republican margin. Democrats didn't win a majority of House seats for the next 20 years.

On the health care bill, there can be little doubt about public opinion. Quinnipiac, polling just after the Senate voted cloture, found Americans opposed by a 53 percent to 36 percent margin. Polls suggest that Democrats may suffer as much carnage in the 2010 elections as they did in 1854.

Nor did the Kansas-Nebraska Act settle the issue it addressed. Pro-slavery and anti-slavery settlers fought it out in "bleeding Kansas," and Douglas felt obliged to break with the Democratic administration and disown election stealing by the pro-slavery side. The issue roused a former congressman named Abraham Lincoln to re-enter politics, and he beat Douglas in the popular vote (but not in the legislature) in 1858 and then was elected president in 1860.

A health care bill like the Senate's is unlikely to settle all health care issues either, though the ensuing political struggles will stop somewhere short of civil war. "We aren't done talking about health care," writes Atlantic blogger (and Obama voter) Megan McArdle. "We haven't even really started. Our budget problems are as big as ever, and we just used up both political capital, and some of our stock of tax increases and spending cuts, to pay for something else."

The Senate bill contains provisions that are likely to be revisited. Its language channeling federal and consumer dollars to abortion coverage is opposed, according to Quinnipiac, by a 72 percent to 23 percent margin. Its provision establishing an Independent Medicare Advisory Board and stating that it cannot be abolished except by a two-thirds vote of the Senate is of dubious constitutionality, and even if upheld in a court of law may not pass muster in the court of public opinion. Since when has Congress passed laws that cannot be repealed?

Kansas-Nebraska was an attempt to settle a fundamental issue by legislative legerdemain and political trickery. The Democrats' health care bills are an attempt to settle a fundamental issue by partisan maneuver and cash-for-cloture. As Stephen Douglas learned, such tactics can work for a while, but the country -- and the Democratic Party -- can end up paying a heavy price.

The Congressional Budget Office's score is in for the final Senate health bill, and it's amazing how little Americans would get for so much.

The Democrats are irresponsibly and disingenuously claiming that the bill would cost $871 billion over 10 years. But that's not what the CBO says. Rather, the CBO says that $871 billion would be the costs from 2010 to 2019 for expansions in insurance coverage alone. But less than 2 percent of those "10-year costs" would kick in before the fifth year of that span. In its real first 10 years (2014 to 2023), the CBO says that the bill would cost $1.8 trillion -- for insurance coverage expansions alone. Other parts of the bill would cost approximately $700 billion more, bringing the bill's full 10-year tab to approximately $2.5 trillion -- according to the CBO.

In those real first 10 years (2014 to 2023), Americans would have to pay over $1 trillion in additional taxes, over $1 trillion would be siphoned out of Medicare (over $200 billion out of Medicare Advantage alone) and spent on Obamacare, and deficits would rise by over $200 billion. They would rise, that is, unless Congress follows through on the bill's pledge to cut doctors' payments under Medicare by 21 percent next year and never raise them back up -- which would reduce doctors' enthusiasm for seeing Medicare patients dramatically.

And what would Americans get in return for this staggering sum? Well, the CBO says that health care premiums would rise, and the Chief Actuary at the Centers for Medicare and Medicaid Services says that the percentage of the Gross Domestic Product spent on health care would rise from 17 percent today to 21 percent by the end of 2019. Nationwide health care costs would be $234 billion higher than under current law. How's that for "reform"?

Even MoveOn.org says that the bill is "a massive giveaway" to private insurance companies. The CBO estimates that, from 2015-25, private insurers would receive $1.0 trillion in subsidies from the American taxpayer -- the insurers' apparent price for giving up their freedom and being controlled by the government. Congress would mandate that Americans buy the insurers' product and would redirect massive sums of taxpayer money to make that mandate more feasible. So, if insurance companies are your idea of a worthy object of philanthropy, then Obamacare is for you.

And this is the bill that Ben Nelson has decided to support?

One hopes that Nebraska voters -- and all other voters in other states who have sent Democrats to Washington -- are making a list and checking it twice, keeping track of votes on Obamacare.

As Harry Reid keeps senators in session rather than letting them go home to be with their families and celebrate Christmas, it's important to remember that this bill would not go into effect in any meaningful way until more than an Olympiad from now. Thus, it is the American voters -- and not the current Democratic Congress or the current president -- who will ultimately decide its fate. Providing reminders to representatives in both chambers of that in the coming days will be crucial to beating back the onslaught of proposed legislation that, even if it passes the Senate, would at least have to passed again by the House and would likely have to go back through both chambers in compromised form.

Keep psych ward knives in drawers after fatal stabbings, says chief psychiatrist. THAT should be a big help! (NOT). It's often said that the psychiatrists are nearly as mad as the patients and this seems rather a good example of that

AN inquiry into the stabbing deaths of two patients at a Melbourne psychiatric hospital has come up with seven recommendations, including a requirement that knife sets be kept in drawers.

Last month two patients at the Thomas Embling Hospital - Raymond Splatt and Paul Notas - were stabbed to death. Fellow patient Peko Lakovski is facing two counts of murder.

Victoria's Chief Psychiatrist Dr Ruth Vine conducted an inquiry into the deaths, aided by a team of interstate experts with forensic clinical experience. Dr Vine said the government has accepted all seven recommendations and said the inquiry found that there was a ``very high threshold" of safety at the Thomas Embling.

The inquiry recommended that the hospital find a way for night staff, who may not deal directly with inmates, to come into contact with patients so they can assess their mental state and stability.

It also recommended that the hospital remove boxed knife sets from benches and put them into drawers. It said that while Jardine Unit patients were expected to cook and clean for themselves, ``the immediate and visible availability of implements that could be used as weapons should be minimised".

Other recommendations included the regular monitoring of relationships between the residents, getting more feedback on patients from their family and carers and documenting any early relapses of illness. "It is still the case that there has never been a serious incident committed by a patient on leave or following release from Thomas Embling Hospital," Dr Vine said. "The community can feel confident that Thomas Embling Hospital is well managed." [Two patients murdered and it is "well managed"!!??]

Hitting businesses just ends up hitting the little guy in the end -- as business passes on its increased costs in the form of price rises

THOUSANDS of private hospital patients are being forced to pay gap fees running into hundreds of dollars because of a dispute over price increases between the big health funds and Australia's largest pathology company. The stand-off over a 30 per cent fee increase that Sonic is requiring from members of the second biggest health fund, Bupa Australia, is set to worsen next week when the dispute spreads to Medibank Private. The industry giant estimates some patients could be up to $500 out of pocket after a hospital stay. "We're extremely concerned that Sonic are forcing private health insurance members to pay excessive costs for pathology services, which in the worst-case scenario can be up to several hundred dollars," the managing director of Bupa, Richard Bowden, said. Mr Bowden said the fees demanded by Sonic were up to twice the level set by the Medicare benefits schedule.

Sonic's demand for an increase of more than 30 per cent on current contracted rates was "clearly unaffordable and unreasonable" and was well above prices negotiated with other pathology providers. The breakdown in negotiations has meant that since November 1, Bupa no longer has a contract for no-gap arrangements with Sonic, exposing patients to big surprise bills.

Medibank members will be in the same position once its contract with Sonic expires on December 31. The two funds account for about 200,000 private hospital patients a year.

The Federal Government's 8 per cent cut to Medicare payments for pathology has contributed to Sonic's demand for a big rise from health funds to cover reduced government cover and rising costs, but the Health Minister, Nicola Roxon, refused to comment yesterday. "This is a commercial matter between Sonic and the health funds so it's not something we can comment on," a spokeswoman for Ms Roxon said.

The chief executive of Sonic, Colin Goldschmidt, stood by the fee rises, saying they followed years of inadequate payments from Medicare [government insurer], which reimburses 75 per cent of the official schedule fee, and Medibank [private insurer], which had covered part of the remaining costs. The rises were required to restore viability of many hospital pathology laboratories, which he said were running at a loss. Several other funds had accepted Sonic's terms. "Patients are free to change funds. We believe we cannot go on with the same fee structure we have had with Bupa and Medibank," Dr Goldschmidt said. He dismissed as "scurrilous" the Medibank claim that people could be $500 out of pocket.

The Bupa and Medibank members, who account for more than half of the 10 million Australians covered by health insurance, are the latest group to be exposed to surging gap costs. The Government's cut to Medicare rebates for cataract operations is leaving many patients with $300 gap bills.

The health funds have warned that the pathology rise, which would add millions of dollars to health insurance costs, would feed into premium rises currently before the Health Department.

Carol Bennett, the executive director of the Consumers Health Forum, said her organisation was concerned by the growing trend of pathology companies "to maximise their profits at the expense of vulnerable consumers who are often hit with large and unexpected pathology bills". "This is an industry that has enjoyed above average profits for many years now," Ms Bennett said. "No government can continue to drain taxpayers' money to fund ever-increasing pathology costs without proper checks and balances."

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Background

Postings from Brisbane, Australia by John Ray (M.A.; Ph.D.) -- former member of the Australia-Soviet Friendship Society, former anarcho-capitalist and former member of the British Conservative party.

This blog gives a lot of attention to events in Australia and Britain -- places where there already exist systems similar to the one most likely to befall the USA if the Democrats get their way -- "Free" medical care supposedly available to all through government hospitals but with a competing private sector as well. The Canadian system is considered too Soviet to provide a likely model for the USA

TERMINOLOGY: Many of my posts concern the very instructive state of socialized medicine in Australia. Like the USA, Germany and India, Australia has a system of State governments which have substantial independence from the central (Federal) government and it is they who are mainly responsible for "free" health services. It may therefore be useful to some for me to note the standard abbreviations for the States concerned: QLD (Queensland), NSW (New South Wales), WA (Western Australia), VIC (Victoria), TAS (Tasmania), SA (South Australia).

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Conservatives do NOT object to helping the poor. Government welfare legislation in aid of the poor was in fact first introduced by conservatives -- Bismarck and Disraeli in the 19th century. What conservatives want is for the help to be delivered in a sane manner. And anyone who thinks that government bureaucracies can run hospitals well is completely out of touch with reality.

One of the oldest "free" public hospital systems in the world is that in the Australian State where I live: Queensland. It dates from 1944 (Britain's NHS began in 1948). So its advanced state of decay reveals well where the slow cancer of bureaucracy ends up. It now has three "administrative" employees for every medical employee. All those clerks are really good at curing people, I guess! Frequent bulletins on the flailing but ineffectual attempts to "fix" the system will appear here -- as well as bulletins on the dreadful things it does to patients and the long waits they endure.

On all my blogs, I express my view of what is important primarily by the readings that I select for posting. I do however on occasions add personal comments in italicized form at the beginning of an article.

I am rather pleased to report that I am a lifelong conservative. Out of intellectual curiosity, I did in my youth join organizations from right across the political spectrum so I am certainly not closed-minded and am very familiar with the full spectrum of political thinking. Nonetheless, I did not have to undergo the lurch from Left to Right that so many people undergo. At age 13 I used my pocket-money to subscribe to the "Reader's Digest" -- the main conservative organ available in small town Australia of the 1950s. I have learnt much since but am pleased and amused to note that history has since confirmed most of what I thought at that early age.

I imagine that the the RD is still sending mailouts to my 1950s address!

NOTE: The archives provided by blogspot below are rather inconvenient. They break each month up into small bits. If you want to scan whole months at a time, the backup archives will suit better. See here or here